JMIR Publications

ABSTRACT

Background:

Computerized cognitive training (CCT) aims to mitigate cognitive decline in subjective cognitive decline (SCD) and mild cognitive impairment (MCI). However, adherence and long-term engagement remain challenging in remote CCT interventions.

Objective:

Describe the development and design of the Bern Brain Training (BBT), a tablet-based app to remotely train cognitive functions and assess its feasibility, usability, and acceptability. This is a secondary analysis of a previously published randomized controlled trial (RCT).

Methods:

Unity Game Engine and C# programming were employed to design 16 games targeting episodic, semantic, and working memory, and spatial abilities. We assessed feasibility, usability and acceptability of the BBT (50 sessions in 10 weeks, each 24 min) in n=116 participants with subjective cognitive decline (SCD, n=89) or mild cognitive impairment (MCI, n=27). One session per week was played in-clinic in a group setting of 4-6 participants. Within the main RCT with parallel groups, participants were pseudo-randomized to one of three groups with an allocation ratio of 1:1:1. The BBT was administered in all three treatment groups at different time points. Group 1 (n=36; 31%) started with the BBT (10w), Group 2 (n=34; 29%) started with active control training (10w) and then moved on to the BBT (10w), Group 3 (n=46; 39%) started with the BBT (10w) after a waiting period of 10 weeks.

Results:

Feasibility was high (adherence rate: 5.10±0.69 BBT sessions/week; weekly group sessions: 9.18±1.05; concluded BBT sessions: 5891 (91%)). On a 7-point Likert scale, participants showed high motivation across cognitive domains and training groups (M=6.15, SD=1.05) and groups did not differ significantly in adherence (P>.05). Usability was good with 61 (0.94%) help button presses recorded across 6489 sessions played. Acceptability (7-point Likert scale) was satisfying in game experience ratings of entertainment (5.43±1.39), with low frustration rates (3.01±1.79), despite the BBT being perceived as challenging (5.52±1.22). The games were perceived as most efficient in training memory (M=5.7, SD=1.20) and thinking abilities (M=5.43, SD=1.18). SCD and MCI did not differ significantly in game experience and perceived game efficacy (P>.05).

Conclusions:

The BBT demonstrated high feasibility, usability, and acceptability. Its innovation lies in the participatory and professional game design, task diversity, adaptivity, and social elements, with a large sample size that sets it apart from other studies. These findings advance the field by demonstrating that tablet-based, remote cognitive training is feasible and well accepted in older adults with cognitive impairment, emphasizing the importance of these parameters for high training adherence and supporting its potential integration into clinical practice. Future research should extend evaluation to care-home settings and populations with more advanced cognitive impairment. Clinical Trial: Trial registration: 1 July 2020 at clinicaltrials.gov (NCT04452864). Funding: Swiss National Science Foundation (2003B 189240).